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  • Title: Use of Norplant implants in a New York City clinic population.
    Author: Gerber S, Westhoff C, Lopez M, Gordon L.
    Journal: Contraception; 1994 Jun; 49(6):557-64. PubMed ID: 8070260.
    Abstract:
    Two-hundred-eight women attending family planning clinics in New York City who received the Norplant contraceptive system during the first sixteen months of Norplant implants insertions were evaluated. Within this clinic population, Norplant implants were a popular contraceptive choice and were removed from 64 of the 208 recipients. Reasons for removal included bleeding, weight gain, and headache, and were consistent with those found in the clinical trials. Prior satisfaction with oral contraceptives did not predict success or failure with Norplant implants. The rate of follow-up visits to the family planning clinics was low. However, evidence exists that these women did not lose contact with the medical center and continued to receive health care. An analysis is provided of 208 women who accepted Norplant between March 1991 and July 1992 at Columbia Presbyterian Medical Center in New York City. About 9600 patients attended the family planning clinics during the study period. The findings indicated that 45% of Norplant users were insured by Medicaid, 52% were not charged, and 3% paid in full or partially. The waiting list for Norplant was 400 persons long due to budget constraints and limited product availability. There were 353 visits among 170 Norplant users by October 20, 1993, of which 25% took place within the first month following insertion. The mean follow-up time after insertion was 10.8 months for 208 patients and 11.9 months for those with any follow-up visit. Follow-ups visits were similar for teenagers and adults. 64 women returned for removal by October 20, 1993. The mean duration of use before removal was 12.1 months. The reasons for removal were given as irregular bleeding, weight gain, and headache. The mean age of those with implants removed was 26.1 years. 19.0% of Norplant acceptors were teenagers, of whom 64.0% were discontinuers. One ectopic pregnancy occurred at 24 months, and one intrauterine pregnancy occurred at 14 months. The ectopic pregnancy did not require surgery. 163 users had a contraceptive history. 93% had used oral contraceptives, and 56% had discontinued use due to side effects. The mean duration of implant use was 19.9 months distributed as follows: 45 women for 16 months, 89 women for 16-23 months, 35 women at 23-28 months, and 39 women after 28 months. The removal rate was 19/100 woman years. Teenage removal rate was 2.7/100 woman years. The first 12 months removal rate among 179 women was 15/100 woman years. The two-year removal rate was 32/100 woman years. The return visit rate was considered low, and acceptance was considered high among a Hispanic population; continuation was high among teenagers.
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